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NPI Code Detail

MEDICARE: DR. ROBERT HARRISON WILSON MD

MEDICARE: DR. ROBERT HARRISON WILSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD00014627WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407858186
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT HARRISON WILSON MD
Provider Business Mailing Address
First Line : 4401 BRIDGEPORT WAY W
Second Line : SUITE 100
City : UNIVERSITY PLACE
State : WA
Zip : 98466-4201
Country : US
Telephone Number : 253-564-4157
Fax Number : 253-564-4813
Provider Business Practice Location Address
First Line : 4401 BRIDGEPORT WAY W
Second Line : SUITE 100
City : UNIVERSITY PLACE
State : WA
Zip : 98466-4201
Country : US
Telephone Number : 253-564-4157
Fax Number : 253-564-4813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 04/24/2014

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Directions to “ DR. ROBERT HARRISON WILSON MD” Practice Location

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